Individual
DR. GUILLERMO V CRISOLOGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
620 JEFFERSON ST, PORT CLINTON, OH 43452-2413
(419) 734-3116
(419) 734-5786
Mailing address
620 JEFFERSON ST, PORT CLINTON, OH 43452-2413
(419) 734-3116
(419) 734-5786
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
35-032803
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0157397
—
OH
01
—
25500
ANTHEM BCBS OF OHIO
OH
Enumeration date
08/27/2006
Last updated
07/08/2007
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